title: An analysis of the motivating and risk factors for conversion from implant-based to total autologous breast reconstruction.
abstract: BACKGROUND
  Problems with implant-based breast reconstructions can lead to patient dissatisfaction and a request for total autologous reconstruction. This 12-year study aimed to determine the rate of conversion from implant-based to autologous reconstruction, to identify potential risk factors, compare the rate of conversion in implant-only and latissimus dorsi/implant reconstructions, and assess patient satisfaction following conversion.
  
  
  METHODS
  Implant-based reconstructions performed between 2000 and 2008 were reviewed. The cohort was then followed prospectively until 2012.
  
  
  RESULTS
  One hundred thirty-nine implant-based reconstructions were performed in 118 patients. Sixty-nine patients underwent latissimus dorsi/implant (80 breasts) and 49 underwent implant-only reconstructions (59 breasts). Twenty-one underwent bilateral reconstructions following risk-reduction surgery. Sixteen percent (19 of 118) of patients and 14 percent of breasts (19 of 139) underwent conversion to autologous tissue. None of the 21 bilateral cases converted (hazard ratio, 4.6; p < 0.05). Median time to conversion was 64 months (range, 18 to 142 months). The main motivating factors for conversion included poor aesthetic result (36.8 percent), capsular contracture (31.6 percent), change in weight (21.1 percent), and implant infection/extrusion (10.5 percent). Implant-only reconstructions were more likely to convert (hazard ratio, 3.6; p < 0.05) and at an earlier stage (p < 0.05) than latissimus dorsi/implant reconstructions. Neither radiotherapy (p = 0.68) nor capsular contracture (p = 0.94) significantly increased the risk of conversion. The BREAST-Q demonstrated high patient satisfaction after conversion.
  
  
  CONCLUSIONS
  Autologous tissue conversion offers a definitive means of improving the quality of the result, patient satisfaction, and quality of life in troublesome implant-based breast reconstructions. Latissimus dorsi coverage of implants and bilateral reconstructions appear to be protective.
  
  
  METHODS
  Risk, III.
authors.affiliation: Newcastle-upon-Tyne, United Kingdom From the Department of Plastic and Reconstructive Surgery, The Newcastle NHS Trust.
authors.forename: Sujatha
authors.initials: S
authors.lastname: Tadiparthi
authors.forename: Helen
authors.initials: H
authors.lastname: Staley
authors.forename: Nicholas
authors.initials: N
authors.lastname: Collis
authors.forename: Joe M
authors.initials: JM
authors.lastname: O'Donoghue
mesh_terms: D000328:Adult; D000368:Aged; D018427:Breast Implants / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000941:ethics / Q000379:methods*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013524:Surgical Flaps; D013997:Time Factors; D014182:Transplantation, Autologous